Pay for Quality Reporting/Performance

Pay for performance is an emerging movement — in which providers are rewarded for the quality of their health care services — among health plans and insurers (the Centers for Medicare & Medicaid Services and others). Some programs are initially providing financial incentives to participate in quality reporting. However, the overall movement focuses on financially rewarding high quality patient care or financially penalizing poor quality of care. The CHA Board has adopted a partial payment or non-payment policy related to billing for preventable adverse events that are under the control of the hospital.

Pay for performance is an emerging movement — in which providers are rewarded for the quality of their health care services — among health plans and insurers (the Centers for Medicare & Medicaid Services and others). Some programs are initially providing financial incentives to participate in quality reporting. However, the overall movement focuses on financially rewarding high quality patient care or financially penalizing poor quality of care. The CHA Board has adopted a partial payment or non-payment policy related to billing for preventable adverse events that are under the control of the hospital.

The Centers for Medicare & Medicaid Services (CMS) has issued the attached notice updating the federal fiscal year (FFY) 2018 inpatient psychiatric facility (IPF) prospective payment system (PPS). CMS notes a 2.6 percent IPF market basket update, reduced by a productivity adjustment of 0.6 percent and an additional 0.75 percent reduction as required by law, for a final market basket update of 1.25 percent. In addition, CMS further reduces payments to IPFs by 0.26 percent as a result of updates to the outlier fixed-dollar loss threshold amount. CMS estimates payments to IPFs will increase by 0.99 percent, or approximately $45 million, compared to FFY 2017.

In addition, CMS finalized changes to the IPF Quality Reporting Program (QRP) as part of the FFY 2018 inpatient prospective payment system final rule. CMS is not finalizing its proposal to add an additional measure, Medication Continuation Following Inpatient Psychiatric Discharge (NQF #3205), to the IPF QRP. CHA expressed concerns with the measure in its comments on the proposed rule and is pleased that CMS has not finalized the measure.

CMS used administrative claims with dates of service between Jan. 1 and Aug. 31, 2016, that were processed between Jan. 1 and Nov. 30, 2016, to estimate QP and partial QP status. Its analysis, based on historical Part B claims data, predicted that nearly 100 percent of eligible clinicians in advanced APMs for whom data is currently available will be QPs in performance year 2017. CMS also predicted whether clinicians are likely to be eligible for the 5 percent APM incentive payment in the 2019 payment year.

The Centers for Medicare & Medicaid Services (CMS) has posted a number of resources related to the Skilled-Nursing Facility Quality Reporting program, including a video of a program webcast held Sept. 14. The video addresses new reporting requirements that became effective Oct. 1.

The Centers for Medicare & Medicaid Services (CMS) has announced that preview reports are available via the Certification and Survey Provider Enhanced Reports (CASPER). The reports will be available until Jan. 10, 2017. The preview period provides inpatient rehabilitation facilities (IRFs) and long-term acute care hospitals (LTCHs) the opportunity to review their data prior to public posting on the IRF or LTCH Compare websites. Should an IRF or LTCH discover discrepancies with its report, it must contact CMS prior to the end of the 30-day preview period to request a review.

The Centers for Medicare & Medicaid Services (CMS) has made available new tools to assist facilities participating in the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program. CMS has updated the IPFQR program manual to reflect new information, including details about data reporting, sampling and submission on the these measures: SUB-3/3a and 30-Day All-Cause Unplanned Readmission Following Psychiatric Hospitalization in an IPF. The manual also provides additional information to assist with the collection of the Transition Record with Specified Elements Received by Discharged Patients and the Timely Transmission of Transition Record measures.

Other changes include new and updated IPFQR program abstraction tools, which provide an optional, informal abstraction mechanism to assist IPFs in data collection. More information about these resources is available on the Quality Reporting Center website under IPFQR Program Resources and Tools.

The Centers for Medicare & Medicaid Services (CMS) has posted provider preview reports for the Inpatient Rehabilitation Facility (IRF) and Long-Term Care Hospital (LTCH) Quality Reporting programs. The reports, which include performance data for several quality measures, are available until Sept. 30. IRFs and LTCHs are encouraged to review the data prior to public display on the IRF Compare or LTCH Compare websites. While corrections to the data are not possible during the 30-day preview period, providers may request a CMS review if they believe the data is inaccurate. For more information on how to access facility data, visit: